MEDICARE: MELANIE BAEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	9116859	FL

General Provider Information

NPI Number	:	1669110656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE BAEZ

Provider Business Mailing Address
First Line	:	125 N ORLANDO AVE STE 101
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-3605
Country	:	US
Telephone Number	:	727-382-0190
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 N ORLANDO AVE STE 101
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-3605
Country	:	US
Telephone Number	:	727-382-0190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2022
Last Update Date	:	01/13/2023

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Directions to “ MELANIE BAEZ ” Practice Location

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